Placenta · 2026
Association between early pregnancy thyroid function and placental-to-fetal weight ratio (PWR): A large-scale retrospective cohort study.
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Feng Weiwei, Su Yan, Shi Yiru, Meng Yu
Аннотация
OBJECTIVE: This large retrospective study aimed to investigate the association between first-trimester thyroid function and the placental-to-fetal weight ratio (PWR), as well as the relationship between PWR and adverse pregnancy outcomes.
METHODS: A total of 34,193 singleton pregnancies were included. Univariate and multivariate logistic regression models examined associations between free thyroxine (FT4), thyroid-stimulating hormone (TSH), and abnormal PWR. Stratified analyses assessed effect modifications, and likelihood ratio tests evaluated nonlinear relationships among thyroid hormones, PWR, and adverse outcomes.
RESULTS: FT4 showed a bidirectional association with PWR. Higher FT4 levels were linked to a reduced risk of low PWR (OR = 0.98 [CI 0.96-1.00], P = 0.021) and an increased risk of high PWR (OR = 1.02 [CI 1.00-1.04], P = 0.025). In women ≥35 years, the protective association was stronger (OR = 0.91 [CI 0.86-0.97], P = 0.002). TSH exhibited a J-shaped nonlinear association with PWR, increasing the risk of low PWR (OR = 1.07 [CI 1.02-1.11], P = 0.002), with a significant interaction in the IVF subgroup (P = 0.036). PWR showed nonlinear associations with outcomes including macrosomia, preterm birth, SGA, emergency cesarean delivery, and fetal distress, with an optimal range of 0.18-0.20. Preeclampsia and GDM were linearly associated with higher PWR. Mediation analyses showed minimal mediation by PWR in the associations between maternal thyroid hormones and adverse pregnancy outcomes.
CONCLUSION: This study found that thyroid function in early pregnancy is associated with late-pregnancy placental efficiency marker PWR, which is also linked to multiple adverse pregnancy outcomes.
METHODS: A total of 34,193 singleton pregnancies were included. Univariate and multivariate logistic regression models examined associations between free thyroxine (FT4), thyroid-stimulating hormone (TSH), and abnormal PWR. Stratified analyses assessed effect modifications, and likelihood ratio tests evaluated nonlinear relationships among thyroid hormones, PWR, and adverse outcomes.
RESULTS: FT4 showed a bidirectional association with PWR. Higher FT4 levels were linked to a reduced risk of low PWR (OR = 0.98 [CI 0.96-1.00], P = 0.021) and an increased risk of high PWR (OR = 1.02 [CI 1.00-1.04], P = 0.025). In women ≥35 years, the protective association was stronger (OR = 0.91 [CI 0.86-0.97], P = 0.002). TSH exhibited a J-shaped nonlinear association with PWR, increasing the risk of low PWR (OR = 1.07 [CI 1.02-1.11], P = 0.002), with a significant interaction in the IVF subgroup (P = 0.036). PWR showed nonlinear associations with outcomes including macrosomia, preterm birth, SGA, emergency cesarean delivery, and fetal distress, with an optimal range of 0.18-0.20. Preeclampsia and GDM were linearly associated with higher PWR. Mediation analyses showed minimal mediation by PWR in the associations between maternal thyroid hormones and adverse pregnancy outcomes.
CONCLUSION: This study found that thyroid function in early pregnancy is associated with late-pregnancy placental efficiency marker PWR, which is also linked to multiple adverse pregnancy outcomes.